Do you aspirate before giving an IM deltoid injection?

Nurses Medications

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I am hoping someone can clear up this issue for me! I am finishing up my last semester in an ADN program. Graduation is December 16th! ? In school we are taught when giving IM injections to aspirate first to check for blood return. If it is clear you give the injection. Is this true when giving an IM injection in the deltoid? I am feeling confused about this because I did a free flu vaccination clinic and the RN (who is also the school's LPN instructor) told us that when giving an injection in the deltoid there is no need to aspirate. The other day I was giving an IM injection and my preceptor told me you always aspirate with any IM injection, but she couldn't find a hospital policy on this. So which way is the correct procedure?

I appreciate any reply on this matter!

I was taught in school to aspirate. But sometimes circumstances make it less than ideal. When medicating an agitated, adrenaline fueled psych patient who's being restrained by a half dozen staff, you need to consider the safety of the patient and staff.

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When I was in school we were told to always aspirate, I even witnesses a fellow classmate aspirate blood. She of course, pulled the syringe out and tried again with a new syringe. The only time we were told to not aspirate was with one shot needles, since they lock up after pushed.

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Specializes in Med-surg, Ed, Trauma, ICA, LTC.

I agree with above. Research based practice will be changing many "Obvious truths" in nursing's future. No more egg white or milk on decubitus ulcers. LOL

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I always aspirate because that is what was protocol in the office I worked--twice in a years time I aspirated blood. Once was with an extremely skinny 12 yr old and the other with an obese teen. No rhyme or reason but I have given hundreds of vaccines and had it happen twice. Both were deltoid.

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I don't aspirate when giving vaccines, but I do with other drugs.

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Specializes in MR/DD.

Very Interesting thread. I have a question to add... what about an Air lock?

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Specializes in Education, Administration, Magnet.

I have changed many of my practices based on research and EBP. Just because I was taught to do it one way during nursing school and I have done it that way for 10 years, does not mean that I don't need to improve my practice. It is my duty to the patient to stay current. This includes no aspiration prior to an IM injection, which is something we are teaching to all of our nursing students at the university where I work.

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Specializes in Obstetrics.

My first semester of nursing school, when we were taught injections, we were told to aspirate. After that semester, we were told not to. And I haven't since.

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Specializes in Emergency Department.

We were taught to aspirate when doing vaccines, unless using a one-time use syringe. The other thing we were taught was not to be too aggressive with aspirating. This limits unnecessary tissue damage from damaging cells by applying too much vacuum to them. I know that EBP says you don't have to aspirate, but every so often you could very easily end up in an artery or a vein, so... some aspiration should detect that. Will I aspirate in the future? Yes, just not very aggressively.

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Specializes in Peds.

Go with what your hospital policy says... that is what will cover you. The nursing schools that attend my work say not to aspirate anymore, and I too was taught to always aspirate with IM. We are no longer aspirating when giving Hep B to infants, but our policy currently says to aspirate for adults, so that is what we are doing until they decide to change the policy.

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I aspirated blood once during an IM deltoid injection. It was the only time it's ever happened. And I give a lot of IM injections. I was pretty shocked. Up until that point I was beginning to think the aspiration of blood was something of an old wives tale.

So if it IS possible to hit a blood vessel, how can EBP say aspirating is not necessary? I was smack dab right on the deltoid muscle and I sure as heck got blood when I pulled back. It's obviously rare, but it happens.

If I hadn't aspirated, as current EBP apparently indicates, I would have injected medication intended intramuscularly directly into someone's blood stream. EBP can be proven wrong. Once upon a time it WAS EBP to a aspirate, after all.

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Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.

We weren't taught to aspirate in school and if EBP says no aspiration then that's good enough for me.

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